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EFFECTS OF PROGESTIN-ONLY LONG-ACTING REVERSIBLE
CONTRACEPTION ON METABOLIC MARKERS IN OBESE WOMEN
by
Nicole Mosteller Bender
________________________________________________________________
A Thesis Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE
(CLINICAL AND BIOMEDICAL INVESTIGATIONS)
May 2011
Copyright 2011 Nicole Mosteller Bender

Background: The obesity epidemic among reproductive age women in the United States necessitates that contraceptives be studied in this population given the need for effective long-acting contraception that does not increase their already elevated risk for cardiovascular and metabolic disease. Previous research suggests that progestin-only contraception may decrease HDL-C cholesterol. While a small decline in HDL-C may not affect the long-term risks for normal weight women, this may have a more profound clinical impact in obese women (BMI ≥30 kg/m2). The metabolic effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) have been studied in normal weight women, but not in obese women.; Objective: The primary objective of this study is to determine if treatment with the levonorgestrel-releasing intrauterine system (LNG-IUS) alters metabolic markers and components of metabolic syndrome in obese women differently than obese users of non-hormonal contraception (NHC).; Methods: This study is a prospective cohort of reproductive age women with BMI ≥30 kg/m2 who do not intend to change lifestyle behaviors during the 6 month study period. Planned enrollment includes 20 subjects; 10 initiating LNG-IUS, and 10 using non-hormonal methods. Components of metabolic syndrome [fasting blood glucose (FBG), HDL cholesterol (HDL-C) and triglycerides (TG), systolic and diastolic blood pressure (SBP, DBP), abdominal circumference (AC),] will be evaluated at baseline, 3 months and 6 months after the initiation of use. At all time points, subjects will complete a validated questionnaire regarding diet and exercise habits.; Results: Twelve subjects have completed both the baseline and Month 3 visit; 6 subjects using LNG-IUS and 6 subjects using non-hormonal method of contraception (NHC). Subjects of both groups were similar in mean age, parity, BMI, and history of gestational diabetes. There were more African-American women that chose NHC and those that chose NHC were also more likely to have a family history of diabetes (p=0.01 and p=0.04, respectively). Baseline parameters of metabolic syndrome did not differ between the two groups with the exception of systolic blood pressure (119 mm Hg in NHC vs 110 mm Hg in LNG-IUS, p=0.03). The LNG-IUS group had mean decrease in HDL-C of 8.5 mg/dL and mean increase in fasting glucose of 10.7 mg/dL at 3 months, while the NHC group had mean increase in HDL-C of 0.5 mg/dL and meaning increase in fasting glucose of 1.7 mg/dL. Although these were considered clinically significantly, they were not statistically significantly different than the non-hormonal group (p=0.06 and p=0.09, respectively).; Conclusion: There is a clinically significant decrease in HDL-C and increase in fasting glucose among obese women using LNG-IUS during the first three months of use. Since it has been shown that increasing HDL-C levels by as little as 1mg/dL has significant impact in reducing cardiovascular risk by 2-3%, this decline in HDL-C levels may be concerning if it persists over the longer follow-up period. This study found that obese women may have different metabolic responses to progestin-only contraception than non-obese women.

i
EFFECTS OF PROGESTIN-ONLY LONG-ACTING REVERSIBLE
CONTRACEPTION ON METABOLIC MARKERS IN OBESE WOMEN
by
Nicole Mosteller Bender
________________________________________________________________
A Thesis Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE
(CLINICAL AND BIOMEDICAL INVESTIGATIONS)
May 2011
Copyright 2011 Nicole Mosteller Bender